15991 POST THIS CARD NEAR FRONT OF„BUILDING I
PERMIT NUMBER I .”
CITY OF CUPERTINO '15991
INSPECTION DIVISION
JOB INSPECTION RECORD .
``// ,�rJ� }.p PERMIT EXPIRATION
JOB ADDRESS�O1a3,�1/, R/DLFa' /\D �IT#` LOT#
'J.
PERMIT EXPIRES IF WORK 1
OWNER F ��L'Tp"-�/ nd�T =CONTRACTOR y,•/y S .CO.V fT IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU..;
FOUNDATION ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION:
UFER ALL GRADING AND DRAINAGE SHALL�BE INSTALLED
PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS ,
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 4I
UNDERGROUND IISLAB
PLUMBING 1 -
ELECTRICALISSUANCE DATE
MECHANICAL - - - BLOc. FLECT. PLG. MEC..
- 19 ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED f G PERMIT
WOOD FLOOR MATION
VAWATION SIFT.
' .PLUMBING � COPB�IDO I ,
MECHANICAL I'm a
ELECTRICAL - .�P.EERRMII TO
FRAMING
INSULATION - STORIES TYPE CONSTR.
OCG.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so Er.FLOOR ARUA TOTAL ACREACL
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING RES IND CON PIT Go- .
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ROUGH' SAN.H
ASSESSOR '
5 PAR CEL NO.
• �
PLUMBING ELECT.ENERGY,
TRACT NO. PARCEL NO.
TUBS&SHOWER PAN PLUMBING ENERGY -
MECHANICAL - MECH.ENERGY
ELECTRICALBUILDING ENERGY ACC.DATE ACC FILE NO
FRAMING ELECT.FINAL TEST
' ZONING ENG.SITE NO.
INSULATION - PLUMBING -
GAS TEST GAS
MECHANICAL FIRE SPR INK ENERGY T 24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING v E] "❑ 'v E] NE_
EXTERIOR SHEAR - -
ELECTRICAL RELEASE FLOOD ZONE A.LUC,
L INTERIOR-SHEARFIRE DEPT. - Y❑ NE] 1 ❑ N❑'i
SHEETROCK GRADE r FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARYPPROVALS BUILDING,
SCRATCH,COAT ELECTRIC PLAN CHECK -
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR- MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC'
H ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
j z PLEASE GIVE JOB•ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — . MECHANICAL7�
IMPORTANT! " coNsr.Tnx
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
'
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING Ofa�Cr ' APPLICATION PERMIT
ADDRESS BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
15991
JJJ1 _
W $
v
PLAN CHECK VALIDATION
CITY. ELECTRIC PERMIT FEE _
INE
CONTRACTOR R 's ^ UTLETS-SWITCHES-RECEP 10:00/1.00
D uC.NO. LIGHTING FIXTURES. 10.00/1.00
CONTRACTOR'S
ADDRESS APPLIANCES-RESIDENTIAL 4,00
' hItF PHON PANELS 10.00 DATE OF APPLICATION 1
ARCHITECPLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP) -20.00
ENGINEER
LIC.NO. ISIGNS TRANS. 3.00 -
ADDRESS ENG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANT'S
ADDRESS MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
.02 `LICENSIiD CONTRACTORS DECLARATION -
Q u ta I hereby affirm that I am licensed under provisions of Chapter
z-w ISSUANCE GATE
a,, Q H (commencing with-Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
H m z Professions Code, rd my license is in full fore d ff ,g ❑ ❑ ❑
z aI w- License / -/ - V Lic.Number
Z
r m- Dale Cnnlrador . .
¢'Q w a OWNER-BUILDER DECLARATION
BUILDING PERMIT
3 o a o INFORMATION
X g H 1 hereby affirm that 1 um exempt.from the Contractor's License MISC.- REFER TO ORD
u O j Law for the t'011owing reason.(Sec.7031.5,Business anti Professions VALUATION $/FT.
- PERMIT ISSUANCE 10.00
y0 Code:Any city orcotiny which requiresu perm it toconslruct,alteq
¢ a, ¢ 0 improve,demo1sh,or repair any structure,prior to its issuance,a150 ELEC.CONTR. LIC.NO. ELEC. -
iO ¢ requires the applicant for such permit to file a signed statement that TOTgL PERMIT TO
L, m u. he is licensed prs
uuant to the provisions of the Contractor's License -
F z ¢
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe AA
4 at Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE a /_6
¢ F a the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the upplieant to a civil penalty
of not more than five hundred dollars($500).): ALTER-DRAIN&VENT•WATER (EA.) 5.00
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 DEC.GROUP .
their sole compensation,will do the work,and the structure is not RES.UNITS
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 50.FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve.
menu are not intended or offered for sale If.however,the building GAS-EA.SYSTEM-11 NC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner
builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4.(EA.) 2.00 BUILDING USE
prove for purpose of sale.). RES IND CON. PS Other
❑ I,as owner of the property:am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 E] ❑ El 0 E]
licensed Contractors m construct the project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 - ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply -
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00
contracts for such projects with a conlractons)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM - 5.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPIiNSA'I'ION DECLARATION WATER TREATING EQUIP. 5.00 -
I hereby affirm that I have a certificate of canxnt to self-insure,
or a certificate of Workers'Compensation Insur nc',or a certifed ZONING ENG.SITE NO.
cnpPpYrrIJ�q�r�.,q.r�(�ay �'ypya9 ab.C.)'/C F
PQI*q{(/YJlJ]r !N ,nya_!-
O ❑ Certified copy is hereby furnished.
❑ Cer ifre y�y f�Ia.J w' the in tion division. FIRE SPRINK ENERGY T-24
H z0� Applicant _fl_.J rant" n e MISC.-+ REFER Y N� Yo N[]
y CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10. FLOOD ZONE A.L.U.D.
LU COMPENSATION INSURANCE PLG.CONTR, LIC.NO. p GCL ,
0 (This section need not he Completed if the permit Is for one L YE] NE] Y [] N�
hundred dollars(S 100)or less.)
V O 1 certify that in the performance ot'the work for whichthis per- MECHANICAL PERMIT ^;yG EE FEE SUMMARY
U. F- mil is issued,I Shull not employ any person in any manner so as to VaN
O w become subject to the Workers'Compensation Laws ofCulit'Grand.
C6 Date ' APPIi°antALTER OR ADD TO MECH. 500 BUILDING
} W NOTICE TO APPLICANT: II',alter making this Certificate of rix . .
'
? c n,gion,you should become ulhjca to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE '
'CJ such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) •4.99
CONS'TRUCT'ION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000QEM.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFI LM'
3097,Civ.C.L HEATING UNIT(TO 100,000 B.T.U.) 6.00
Lender's Name HEATI NG UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
1 certify that 1 have read this application and state that the aboveVENTILATION FAN (SINGLE) -4.9
information is correct. I agree to comply with all City and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and stare laws relating to building construction, and
hereby authorize representatives of this city to enter upon the
above-mentioned property I'or inspection purposesBOILER-COMP (Over 100,000 BTU(SEE FEE SCH. MECHANICAL a7 S�
.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
in ay in a way ace e.against said City in consequence of the PERMIT ISSUANCE 4e:oe a "-
O this IM' MECH.CONT. LIC.NO. MECH.
d
Ma ANti� TOTAL �7 TOTAL
Signature of Applicar omlractor Date /
OFFICE COPY